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BACKGROUND: Therapeutic climbing (TC) has emerged as a prospective rehabilitation approach for individuals with multiple sclerosis (MS). The existing literature primarily focuses on the physical and psychological benefits of TC across diverse populations but is limited concerning its application and efficacy for patients with MS. OBJECTIVES: This study aimed to delineate the experiences, subjective effects, and perceptions of both individuals with MS and therapists regarding TC, highlighting the potential benefits and challenges of this therapeutic approach. METHODS: Using a qualitative design, semi-structured interviews were conducted with patients living with MS (N = 5) and therapists (N = 7) involved in TC sessions at a rehabilitation facility. The interviews were recorded, transcribed verbatim, and subjected to thematic qualitative text analysis. RESULTS: Our analysis resulted in the identification of five main categories: (1) motivational factors, (2) training conditions, (3) training content, (4) observed effects, and (5) safety protocol. Our findings primarily centred around the motivational aspects of TC. Participants consistently reported experiencing feelings of accomplishment, success, enjoyment, and increased self-confidence. Furthermore, TC was often perceived as a comprehensive intervention, addressing endurance, strength, flexibility, neuromotor functions, cognition, and mental health while having a low-risk profile. However, due to the demanding nature of TC, careful fatigue management is crucial. This entails personalised intensity adjustments during sessions and coordinating TC with other physically demanding therapies when implementing TC within a rehabilitation environment. CONCLUSIONS: TC shows promise within MS rehabilitation and can be considered safe under certain framework conditions. This research sheds light on its potential benefits, facilitators, and barriers and provides insights for practical integration into rehabilitation programs.
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In the context of evaluating physical function in individuals with stroke, the 3-Meter Backward Walk Test (3MBWT) emerges as a potential tool of interest. The purpose of this study was to assess the test-retest reliability and concurrent validity of the 3MBWT and its correlation with falling incidents. Conducted in a neurological rehabilitation center, 35 ambulatory individuals with stroke were enrolled within a month post-stroke onset. These participants, with a Functional Ambulation Category score of ≥4, underwent the 3MBWT, Functional Gait Assessment (FGA), 10-Meter Walk Test (10MWT), and 6-Minute Walk Test (6MWT) under the supervision of different physiotherapists. The results indicate that the 3MBWT demonstrated high reliability, with an Intraclass Correlation Coefficient of 0.97 (95% CI: 0.95, 0.98). It also showed significant concurrent validity with other established walking tests like the 6MWT (r = -0.78) and 10MWT (r = 0.71), with a moderate correlation with the FGA (r = -0.54). No marked differences in test outcomes were observed between participants based on their fall history. Conclusively, the 3MBWT proves to be highly reliable and agrees well with existing walking function assessments for stroke patients, suggesting its potential as a time-efficient alternative.
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BACKGROUND AND PURPOSE: Successful long-term treatment of spasticity in people with multiple sclerosis (pwMS) is challenging. We investigated the effects of multidisciplinary inpatient rehabilitation (MIR) and an individualized self-training program delivered by an app on spasticity in pwMS. METHODS: First, we assessed the efficacy of 4-week MIR in ambulatory pwMS (Expanded Disability Status Scale < 7.0) with moderate to severe lower limb spasticity (defined by ≥4 points on the Numeric Rating Scale for spasticity [NRSs]) in a cohort of 115 pwMS at seven rehabilitation centers in Austria. In the case of a clinically relevant improvement in spasticity of ≥20% on the NRSs following MIR (n = 94), pwMS were randomly allocated in a 1:1 ratio to either the newly designed MS-Spasticity App or to a paper-based self-training program for 12 weeks. The primary outcome was change in NRSs (German Clinical Trials Registry DRKS00023960). RESULTS: MIR led to a significant reduction of 2.0 points on the NRSs (95% confidence interval [CI] = 2.5-2.0, p < 0.000). MIR was further associated with a statistically significant improvement in spasticity on the Modified Ashworth Scale, strength, and all mobility outcomes. Following MIR, self-training with the MS-Spasticity App was associated with a sustained positive effect on the NRSs, whereas paper-based self-training led to a worsening in spasticity (median NRSs difference = 1.0, 95% CI = 1.7-0.3, p = 0.009). The MS-Spasticity App was also associated with a significantly better adherence to self-training (95% vs. 72% completion rate, p < 0.001). CONCLUSIONS: In pwMS, MIR is able to significantly improve lower limb spasticity, strength, and mobility. Following MIR, an individually tailored antispasticity program delivered by an app leads to sustained positive long-term management.
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Esclerosis Múltiple , Austria , Humanos , Esclerosis Múltiple/terapia , Espasticidad Muscular/complicaciones , Espasticidad Muscular/terapia , Programas InformáticosRESUMEN
OBJECTIVE: The objective of this meta-analysis was to summarize evidence on the therapeutic effects of non-invasive brain stimulation (NIBS) on core symptoms of multiple sclerosis (MS). Specifically, findings from studies deploying transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) protocols were summarized in this review. METHODS: We systematically searched articles published in four databases, until 31 May 2021, which compared the effects of active tDCS or rTMS with sham intervention in MS patients. We used a random-effects model for this meta-analysis. Meta-regression and subgroup meta-analysis were used to examine the effects of stimulation dose and different stimulation protocols, respectively. RESULTS: Twenty-five randomized controlled trials (RCTs) were included in this review, consisting of 19 tDCS and 6 rTMS studies. tDCS led to a significant and immediate reduction of fatigue with a large effect size (Hedges's g = -0.870, 95% confidence intervals (CI) = [-1.225 to -0.458], number needed to treat (NNT) = 2). Particularly, a subgroup analysis showed that applying tDCS over the left DLPFC and bilateral S1 led to fatigue reductions compared to sham stimulation. Furthermore, tDCS had favorable effects on fatigue in MS patients with low physical disability but not those with high physical disability, and additionally improved cognitive function. Finally, whereas rTMS was observed to reduce muscle spasticity, these NIBS protocols showed no further effect on MS-associated pain and mood symptoms. CONCLUSION: tDCS in MS alleviates fatigue and improves cognitive function whereas rTMS reduces muscle spasticity. More high-quality studies are needed to substantiate the therapeutic effects of different NIBS protocols in MS.
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OBJECTIVE: To investigate higher cognitive functions after mimicry changes after facial botulinum toxin (BTX) injections, we tested verbal and nonverbal reasoning in patients with blepharospasm or hemifacial spasm before and after their long-term botulinum toxin treatment. DESIGN: Explorative, nonrandomized, clinical trial. SETTING: Patients receiving ambulatory care and control participants from the general community. PARTICIPANTS: Volunteer sample (N=84) of patients (n=21) with blepharospasm or hemifacial spasm who received facial BTX injections. Control participants included patients (n=30) with cervical dystonia who received cervical BTX injections and individuals without neurological disorders (n=33). INTERVENTIONS: The 2 groups receiving injections were tested before and 3 weeks after their treatment. The group without neurological disorders received no injections. MAIN OUTCOME MEASURES: Verbal and nonverbal reasoning scores. RESULTS: The key unexpected finding was that patients who received facial BTX injections perform significantly worse in nonverbal reasoning tasks, when compared with those who did not receive injections (P=.022). There was no significant difference in the baseline reasoning scores and at follow-up for verbal reasoning between the 3 groups. There was no correlation between toxin dose and reasoning scores (verbal: P=.132; nonverbal: P=.294). CONCLUSIONS: Because of potential confounders, the results do not yet allow any conclusion on causality. Further research is needed to confirm our findings.
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Blefaroespasmo , Toxinas Botulínicas , Espasmo Hemifacial , Blefaroespasmo/tratamiento farmacológico , Toxinas Botulínicas/uso terapéutico , Cognición , Estudios de Cohortes , Espasmo Hemifacial/tratamiento farmacológico , HumanosRESUMEN
Introduction: Botulinumtoxin associated muscle denervation (BNTMD) can be detected by magnet resonance imaging (MRI), MRI may provide further insights into the exact timeline of BNTMD and the potential impact and timing of physical exercise. We aimed to assess the time interval until detection of BNTMD by MRI and whether immediate physical exercise after intramuscular BNT injection has a measurable effect on clinical parameters and the intramuscular denervation dynamics illustrated by MRI. Materials and Methods: Eleven age-matched patients were randomized to an "exercise" or "no-exercise" group. Eighty mouse-units of incobotulinumtoxin were injected into the spastic biceps muscle. MRI of the injected region, hand-held dynamometry of elbow flexor strength and clinical rating scales (mAS, CGI-I) were conducted in predefined intervals. Results: We could not detect BNTMD within 24 h but 7 days after injection independent of group allocation (exercise n = 6, no-exercise n = 5). Denervation signs were more diffuse and spread into adjacent muscles in patients having received exercise. We could not detect differences concerning clinical measures between the two groups. Conclusions: Physical exercise might influence BNTMD dynamics and promote propagation of T2-MR muscle denervation signs from the injected site into adjacent muscles. Trial registration: clinicaltrialsregister.eu, Identifier 2017-003117-25.
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Originally described as a risk factor for autism, CHD8 loss-of-function variants have recently been associated with a wider spectrum of neurodevelopmental abnormalities. We further expand the CHD8-related phenotype with the description of two unrelated patients who presented with childhood-onset progressive dystonia. Whole-exome sequencing conducted in two independent laboratories revealed a CHD8 nonsense variant in one patient and a frameshift variant in the second. The patients had strongly overlapping phenotypes characterized by generalized dystonia with mild-to-moderate neurodevelopmental comorbidity. Deep brain stimulation led to clinical improvement in both cases. We suggest that CHD8 should be added to the growing list of neurodevelopmental disorder-associated genes whose mutations can also result in dystonia-dominant phenotypes.
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Proteínas de Unión al ADN/genética , Trastornos Distónicos/genética , Trastornos del Neurodesarrollo/genética , Factores de Transcripción/genética , Adolescente , Edad de Inicio , Estimulación Encefálica Profunda , Progresión de la Enfermedad , Trastornos Distónicos/fisiopatología , Trastornos Distónicos/terapia , Femenino , Humanos , Persona de Mediana Edad , Trastornos del Neurodesarrollo/fisiopatologíaRESUMEN
OBJECTIVE: Obstructive sleep apnea (OSA) impacts stroke recovery and outcome negatively. Although its identification and treatment are part of the current stroke guidelines, standard management with positive airway pressure (PAP) therapy is not routinely performed and adherence rates are very low. The purpose of this study was to determine whether PAP adherence can be improved by a PAP training strategy during in-hospital rehabilitation combined with a telemedicine monitoring system after discharge. METHODS: In this study, we performed a controlled trial (RCT) on standard PAP treatment (SG) as compared with proactive telemonitored PAP treatment (TG). After three months and one year, PAP adherence (min of use per day) and clinical outcome variables were compared. RESULTS: In 33 (47.1%) out of 70 patients diagnosed with therapy-relevant OSA [70% male, 62 (5) years, body mass index (BMI) 30 (4) kg/m2, Barthel Index 90 (20), NIHSS 3 (3)] in-hospital PAP titration was performed. Subsequently, they were randomized to SG or TG. Drop-out rates after three months and after one year were 12% and 30%, respectively, with no differences between the groups. After three months, telemonitored patients used the PAP device 76 min longer per night (SG: 299 (76), TG: 375 (86) minutes per night; p = 0.017), after one year there was no significant difference. CONCLUSION: People with stroke and therapy-relevant OSA who accept PAP therapy should receive additional telemedicine monitoring at least for three months. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov; Unique identifier: NCT02748681.
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Presión de las Vías Aéreas Positiva Contínua , Cooperación del Paciente , Apnea Obstructiva del Sueño/terapia , Accidente Cerebrovascular/complicaciones , Telemedicina/métodos , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Apnea Obstructiva del Sueño/complicaciones , Resultado del TratamientoAsunto(s)
Toxinas Botulínicas/uso terapéutico , Sensación de Gravedad/fisiología , Fármacos Neuromusculares/uso terapéutico , Plasticidad Neuronal , Tortícolis/fisiopatología , Femenino , Sensación de Gravedad/efectos de los fármacos , Cabeza/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Plasticidad Neuronal/efectos de los fármacos , Postura/fisiología , Propiocepción/efectos de los fármacos , Propiocepción/fisiología , Índice de Severidad de la Enfermedad , Factores de Tiempo , Tortícolis/tratamiento farmacológico , Resultado del Tratamiento , Percepción VisualRESUMEN
OBJECTIVES: MR neurography, diffusion tensor imaging (DTI) and tractography at 3 Tesla were evaluated for the assessment of patients with ulnar neuropathy at the elbow (UNE). METHODS: Axial T2-weighted and single-shot DTI sequences (16 gradient encoding directions) were acquired, covering the cubital tunnel of 46 patients with clinically and electrodiagnostically confirmed UNE and 20 healthy controls. Cross-sectional area (CSA) was measured at the retrocondylar sulcus and FA and ADC values on each section along the ulnar nerve. Three-dimensional nerve tractography and T2-weighted neurography results were independently assessed by two raters. RESULTS: Patients showed a significant reduction of ulnar nerve FA values at the retrocondylar sulcus (p = 0.002) and the deep flexor fascia (p = 0.005). At tractography, a complete or partial discontinuity of the ulnar nerve was found in 26/40 (65%) of patients. Assessment of T2 neurography was most sensitive in detecting UNE (sensitivity, 91%; specificity, 79%), followed by tractography (88%/69%). CSA and FA measurements were less effective in detecting UNE. CONCLUSION: T2-weighted neurography remains the most sensitive MR technique in the imaging evaluation of clinically manifest UNE. DTI-based neurography at 3 Tesla supports the MR imaging assessment of UNE patients by adding quantitative and 3D imaging data. KEY POINTS: ⢠DTI and tractography support conventional MR neurography in the detection of UNE ⢠Regionally reduced FA values and discontinuous tractography patterns indicate UNE ⢠T2-weighted MR neurography remains the imaging gold standard in cases of UNE ⢠DTI-based ulnar nerve tractography offers additional topographic information in 3D.
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Imagen de Difusión Tensora/métodos , Imagen por Resonancia Magnética/métodos , Síndromes de Compresión del Nervio Cubital/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Articulación del Codo/patología , Femenino , Humanos , Imagenología Tridimensional/métodos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Nervio Cubital/patologíaRESUMEN
Our previous work showed a beneficial therapeutic effect on blepharospasm using slow repetitive transcranial magnetic stimulation, which produces a long-term depression (LTD)-like effect. High-frequency supraorbital electrical stimulation, asynchronous with the R2 component of the blink reflex, can also induce LTD-like effects on the blink reflex circuit in healthy subjects. Patients with blepharospasm have reduced inhibition of their blink recovery curves; therefore, a LTD-like intervention might normalize the blink reflex recovery (BRR) and have a favorable therapeutic effect. This is a randomized, sham-controlled, observer-blinded prospective study. In 14 blepharospasm patients, we evaluated the effects of high-frequency supraorbital stimulation on three separate treatment days. We applied 28 trains of nine stimuli, 400 Hz, either before or after the R2 or used sham stimulation. The primary outcome was the blink rate, number of spasms rated by a blinded physician and patient rating before, immediately after and 1 hour after stimulation while resting, reading, and talking; secondary outcome was the BRR. Stimulation "before" and "after" the R2 both showed a similar improvement as sham stimulation in physician rating, but patients felt significantly better with the before condition. Improvement in recovery of the blink reflex was noted only in the before condition. Clinical symptoms differed in the three baseline conditions (resting, reading, and talking). Stimulation before R2 increased inhibition in trigeminal blink reflex circuits in blepharospasm toward normal values and produced subjective, but not objective, improvement. Inhibition of the blink reflex pathway by itself appeared to be insufficient for a useful therapeutic effect.
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Blefaroespasmo/terapia , Parpadeo/fisiología , Estimulación Eléctrica , Plasticidad Neuronal/fisiología , Anciano , Anciano de 80 o más Años , Estimulación Eléctrica/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Tiempo , Estimulación Magnética Transcraneal/métodosRESUMEN
BACKGROUND AND OBJECTIVE: The possible interference of combined laser hair removal and Botulinum toxin A (BoNT/A) injections in the treatment of axillary hyperhidrosis has not previously been explored. In order to examine this potential interference, we assessed the effect of BoNT/A on axillary hyperhidrosis with and without concomitant diode laser axillary hair removal. STUDY DESIGN/MATERIALS AND METHODS: In a prospective, double blind, randomized cross over trial, nine patients suffering from primary axillary hyperhidrosis were laser-treated on one randomly assigned axilla. One week later, both axillas were injected intradermally with BoNT/A (100 MU per axilla). During the same session, the previously untreated axilla was lasered. Axillary sweat rates (in g/5 minutes.) were determined by gravimetry and compared at rest, during mental exercise, and during physical exercise. Additionally, subjective outcome measures were assessed by a visual analogue scale, Dermatology Life Quality Index, and Global Clinical Impression score. RESULTS: No differences were found regarding the effect of BoNT/A on previously laser-treated and laser co-treated sides over time course for any of the outcome parameters. Sweat production was reduced 3 weeks after BoNT/A treatment by 93.5% at rest, 96.5% during mental exercise, and 67% during physical exercise. CONCLUSIONS: Concomitant laser hair removal does not interfere with BoNT/A treatment on axillary hyperhidrosis.
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Toxinas Botulínicas Tipo A/uso terapéutico , Remoción del Cabello/métodos , Hiperhidrosis/terapia , Láseres de Semiconductores/uso terapéutico , Calidad de Vida , Adulto , Análisis de Varianza , Axila , Terapia Combinada , Estudios Cruzados , Método Doble Ciego , Femenino , Estudios de Seguimiento , Humanos , Hiperhidrosis/diagnóstico , Inyecciones Intradérmicas , Estudios Prospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Adulto JovenRESUMEN
The authors report the case of a 32-year-old man who had been treated for anxiety and obsessive-compulsive disorder and had received 800 mg methylphenobarbital (MPB). After switching to a barbiturate-free schedule, his condition continued to be unstable for more than 21 MPB half-lives (approx. 30 days) and did not stabilize until MPB-metabolites dropped below their urinary detection limit. Considering that this article provides findings from a single patient, the authors use this experience to discuss and emphasize the importance of clinical control of barbiturates in psychiatry.
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Ansiedad/tratamiento farmacológico , Barbitúricos/farmacocinética , Trastorno Obsesivo Compulsivo/tratamiento farmacológico , Psicotrópicos/uso terapéutico , Adulto , Ansiedad/metabolismo , Ansiedad/orina , Barbitúricos/administración & dosificación , Barbitúricos/efectos adversos , Humanos , Masculino , Meprobamato/administración & dosificación , Trastorno Obsesivo Compulsivo/metabolismo , Trastorno Obsesivo Compulsivo/orina , Psicotrópicos/administración & dosificación , Psicotrópicos/efectos adversos , Psicotrópicos/farmacocinéticaRESUMEN
Mouse units used to quantify the activity of botulinum A toxin preparations are not equivalent and issues concerning efficacy and safety remain with regard to their respective potencies and diffusion qualities in human tissue. We compared the effects of Botox (BOT) and Dysport (DYS) in different doses and dilutions in a human skin model. Eighteen (8 women, 10 men) healthy volunteers, aged 28.4 years +/- 5.7 years were injected intradermally with pure saline, BOT and DYS at 16 points in the abdomen in random order and in a double-blind condition, using two conversion ratios (1:3 and 1:4) and three different dilution schemes. For an objective outcome, the Ninhydrin sweat test was used to compare the anhidrotic areas. Both preparations showed a linear dose and dilution relationship with similar variances of responses for anhidrosis and hypohidrosis, indicating the same reliability of response. The dose equivalence conversion ratios (BOT: DYS) were 1:1.3 for anhidrosis and 1:1.6 for hypohidrosis (1:1.1-1.5 and 1:1.4-1.8 95% confidence intervals). The diffusion characteristics of both products were similar. A dose equivalence factor of more than 1:2 (BOT:DYS) is not supported by these objective and reproducible data.
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Toxinas Botulínicas Tipo A/farmacología , Piel/efectos de los fármacos , Sudoración/efectos de los fármacos , Abdomen , Adulto , Toxinas Botulínicas Tipo A/administración & dosificación , Toxinas Botulínicas Tipo A/farmacocinética , Difusión , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Femenino , Calor , Humanos , Inyecciones Intradérmicas , Masculino , Reproducibilidad de los Resultados , Adulto JovenRESUMEN
BACKGROUND: Botulinum toxin type A (BoNT/A) is frequently used for cosmetic indications and hyperhidrosis. OBJECTIVES: We investigated whether UV-B irradiation alleviates the BoNT/A effect on local sudomotor activity. MATERIALS AND METHODS: In a randomized, double-blinded trial, the anhidrotic areas after BoNT/A (100 mU) injection 48 hours before and 14 days after UV-B irradiation were compared in six healthy volunteers. RESULTS: UV-B irradiation alleviated BoNT/A effect by approximately 30% (p=.0017). The UV-B-evoked reduction of anhidrotic areas was constant over the observation period of 14 weeks. CONCLUSIONS: When BoNT/A is applied intradermally, excessive exposure to UV-B and sunburn should be reconsidered. The authors have indicated no significant interest with commercial supporters.
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Toxinas Botulínicas Tipo A/farmacología , Fármacos Neuromusculares/farmacología , Rayos Ultravioleta/efectos adversos , Adulto , Toxinas Botulínicas Tipo A/administración & dosificación , Método Doble Ciego , Femenino , Humanos , Masculino , Fármacos Neuromusculares/administración & dosificaciónRESUMEN
BACKGROUND: Pain sensation associated with injections of botulinum neurotoxin (BoNT) is commonly reported. To date differences in pain sensation between the commercially available products containing BoNT have not been quantified. OBJECTIVES: The pain sensations during injection of Dysport, Botox, Neurobloc, and pure saline (control) were compared. In addition, the nociceptive effect of different volumes used for the dilution of the same BoNT dose was investigated. METHODS: In a prospective, double-blind, controlled trial, 10 healthy subjects were injected intradermally with Dysport (12 U), Botox (3 and 4 U), Neurobloc (150 and 300 U) reconstituted in 0.9% saline, and pure saline. Pain sensation was quantified during injections. RESULTS: Neurobloc injections caused significantly more injection pain than Botox, Dysport, and saline. No significant differences between Dysport, Botox, and saline were found, although there was a trend toward less pain with pure saline injections. Higher pain levels with higher volumes could not be demonstrated significantly. CONCLUSION: Our data demonstrate that BoNT type B injections are associated with substantial pain. There is a considerable difference between the commercially available BoNT type B compared to the two BoNT type A preparations. Therefore, considering mitigation of injection pain seems necessary when using BoNT type B.